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Alındığı tarih: 12.12.2018 Kabul tarihi: 14.12.2018 Yayın tarihi: 31.01.2019 Editöre Mektup / Letter to the Editor
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Superficial Cervical Plexus Block Produces
Effective Analgesia in Auricular Reconstruction
Using Postauricular Flap in a Pediatric Patient
Yüzeyel Servikal Pleksus Bloğunun Pediatrik
Hastada Postaurikular Flap ile Aurikula
Rekonstruksiyonunda Etkin Analjezik Etkinliği
Yavuz Gürkan 0000-0002-2307-6943 Kocaeli Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Kocaeli, Türkiye Hadi Ufuk Yörükoğlu
Yavuz Gürkan
Hadi Ufuk Yörükoğlu
Kocaeli Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Umuttepe Kocaeli - Türkiye
✉
[email protected]ORCİD: 0000-0001-7572-1580
JARSS 2019;27(1):74-75 doi: 10.5222/jarss.2019.55265
Dear editor,
Superficial cervical plexus (CPB) block is a well defined regional anesthesia technique and most commonly preferred for superficial neck surgeries. Local anesthetic is injected into the vicinity of the sensory branches of the nerve roots C2-4 which innervate the scalp and neck. This block can be performed easily with both landmark technique or ultrasound guidance, and using ultra-sound ensures the spread of local anesthetic through the correct plane and increases the success rates while decreases the complication rates (1).
A 13 year-old ASA I, 170 cm tall male patient, weighing 62 kg with auricular laceration due to traffic accident presented for reconstruction using a rever-sed flap from postauricular area. Informed consent was obtained from the patient’s parents to present details of the case. The anesthetic block was performed preoperatively. After the appropriate skin disinfection, linear ult-rasound transducer (10-18 MHz Esaote My Lab 5, Geneva, Italy) was placed over the lateral side of the neck in transverse orientation and cervical plexus was visualized under sternocleidomastoid (SCM) muscle. The 22G, 50 mm needle (Braun, Ultraplex, Melsungen, Germany) was inserted using out-of plane approach. After negative aspiration test, 10 ml 0.5% bupivacaine was injected into the fascial plane under SCM (Fig.).
General anesthesia was induced with 2 mg kg-1 iv propofol, 1 mcg kg-1 iv
fen-tanyl and maintained with sevoflurane in 60% N20/40% oxygen. Surgery las-ted for one hour without any adverse event. For postoperative pain manage-ment. 2 mg morphine iv and 1 gr paracetamol iv were administered
The patient was pain free for the first 20 hours. He reported mild pain for the first time at postoperative 20th hour and responded to 500 mg paracetamol
ıv. The patient did not require any systemic analgesic and was discharged home 48 hours after the surgery. Overall, the child and her parents were satisfied with the analgesia technique provided.
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© Telif hakkı Anestezi ve Reanimasyon Uzmanları Derneği. Logos Tıp Yayıncılık tarafından yayınlanmaktadır. Bu dergide yayınlanan bütün makaleler Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı ile lisanslanmıştır. © Copyright Association of Anesthesiologists and Reanimation Specialists. This journal published by Logos Medical Publishing. Licenced by Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
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H.U. Yörükoğlu ve ark., Superficial Cervical Plexus Block Produces Effective Analgesia in Auricular Reconstruction Using Postauricular Flap in a Pediatric Patient
As CPB is frequently performed to provide anesthe-sia for carotid endarterectomy procedures, this block can be also used to provide postoperative analgesia for thyroid and parathyroid surgeries (2). Two
branc-hes of cervical plexus, namely greater auricular nerve (C2-C3) innervates auricula and lesser occipital nerve (C3) postauricular area. There are few cases of CPB performed for ear surgeries in the literature. In our clinic, we previously performed CPB for auricula surgery to provide anesthesia (3). For anesthesia
Ritchie et al. (4) applied CPB only on greater auricular
nerve as sole anesthetic block in elderly patient with high risk for resection of auricular skin lesions. Flores et al. (5) performed greater auricular nerve block in
emergency department for the repair of ear lacerati-on and drainage of ear abscess. Greater auricular nerve block is sufficient for auricular interventions,
but for this case, to provide adequate postoperative analgesia for auricula and postauricular area, we preferred CPB.
Although this case demonstrates that CPB achieves excellent pain control in a pediatric patient who underwent auricular reconstruction using flap har-vested from postauricular area, further studies are needed to determine the analgesic effects for ear surgeries.
REFERENCES
1. Senapathi TGA, Widnyana IMG, Aribawa IGNM, et al. Ultrasound-guided bilateral superficial cervical plexus block is more effective than landmark technique for reducing pain from thyroidectomy. Journal of pain research. 2017;10:1619.
https://doi.org/10.2147/JPR.S138222
2. Gürkan Y, Taş Z, Toker K, Solak M. Ultrasound guided bilateral cervical plexus block reduces postoperative opioid consumption following thyroid surgery. Journal of Clinical Monitoring and Computing. 2015;29:579-84.
https://doi.org/10.1007/s10877-014-9635-x
3. Türkyılmaz N, Aksu C, Gürkan Y. Superficial cervical plexus block in ear surgery: a case report. The Journal of The Turkish Society of Algology.
https://doi.org/10.5505/agri.2018.45762
4. Ritchie MK, Wilson CA, Grose BW, Ranganathan P, Howell SM, Ellison MB. Ultrasound-guided greater auricular nerve block as sole anesthetic for ear surgery. Clinics and Practice. 2016;6:856.
https://doi.org/10.4081/cp.2016.856
5. Flores S, Herring AA. Ultrasound-guided greater auri-cular nerve block for emergency department ear lace-ration and ear abscess drainage. Journal of Emergency Medicine. 2016;50:651-5.
https://doi.org/10.1016/j.jemermed.2015.10.003 Figure. Ultrasound image of superficial cervical plexus block.
